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How do you survive puberty??

Discussion in 'Parents of Children with Type 1' started by roo'smom, Feb 17, 2014.

  1. roo'smom

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    As if puberty isn't difficult enough to handle without diabetes...
    My dd is 11 (she'll turn 12 in July). Over the past 5 months her basals have doubled, and we're still having problems, but of course not all the time. I've been marking the calendar as to when she's running high and when she's not. She is clearly running high more than not, but there is no discernible pattern yet. Two nights ago she had three juice boxes over the course of the night, along with a temp basal down to 20% (-80%) for most of the night. Last night I ran a temp basal of 180% and corrected all night and she still ran high. She hasn't had an actual period yet, just one episode of spotting, probably about 6 weeks ago.
    Her total basal through out the day is up to 32 units. We test every 1.5 - 2 hours at night, particularly when she's running high, because I'm afraid of her crashing, so I don't think she's rebounding.
    She pumps apidra in a MM. When she's running high (300s) I change sites, do shots, etc, but it doesn't seem to make much of a difference. So far she hasn't had any ketones when all of this is going on, so I'm assuming she is getting insulin.
    She's had diabetes for 8 years (since she was 3) and the only change recently is her age. She definitely isn't as conscientious about testing and prebolusing as she could be, but she even runs high when I'm doing it all for her.
    Any tricks, suggestions, etc for dealing with this will surely be appreciated...
     
  2. nebby3

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    No advice, I just wanted to say we're in the same spot. My dd will be 12 in a couple of weeks, dx 10 yrs ago. Her basal is 26u in the AM and 32 at night. We have noticed she needs a lot more at night recently and she definitely rises from 5am on or so. We got a Dexcom a few months ago and it helps a lot. My dd refused to pump though.
     
  3. Michelle'sMom

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    Can I get back to you on that one? :) (Can't get the smilies to work since the switch, sorry)

    My dd pumps & uses the Dex. It's been one long wild ride since about 8 months after her dx (age 11). The only thing that's kept me sane is consistent logging. I know, it's so old school, but it's the only way I can see the big picture.

    A glass of wine every now & then helps a lot too.
     
  4. Mish

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    It's no better for boys either. Seriously, 1.75u per hour basals at night sometimes aren't enough. It's utterly insane. INSANE. I do find that I really have to be on top of any spikes before they get bad because once resistant highs set in, they're impossible to get down. I do like the G4 for this because I find that I'm more confident in what I can do with that amount of insulin.

    I've also learned that what I think is going to be 'too much' rarely is.
     
  5. ksartain

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    Chris just had a growth spurt last week. Know how I know? Three days of high blood sugars and actually used all the insulin in the pod for the first time. I finally figured it was growth hormones, so I cranked up his basal just to see if that worked. And it did. And I think I have to change his I/C ratio as well. I'll call the doctor for that. We were doing so well up until then.
     
  6. sugarmonkey

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    I think we're finally starting to see the light at the end of the tunnel here - DS will be 17 in two weeks.

    For us the big thing was logging. I know a lot of people don't do this regularly, but I found logging everything every few days helped me keep on top of things. When I didn't log, things would go even more nuts. Temp basals were also widely used. As soon as he hit 15, I'd put a temp of at +20 on. I wouldn't wait until we got two high tests, that first high got extra insulin right away. It was rare it was too much and sent him low. Often that wouldn't do much still, and we'd have to increase it even more. We still sometimes get periods where insulin doesn't make a dent in his numbers, but they're getting further apart, and his growth has slowed down.
     
  7. Michelle'sMom

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    The logging is tedious & tiring, but if you can figure out the timing of her cycles (or almost-cycles) it will help you sort things out a bit. I agree that waiting for a 2nd high reading is borrowing more trouble. The insulin resistance in puberty can be a real bear. The sooner you're on top of the highs, the easier it will be to bring them down.

    Read up on estrogen & insulin. Darryl posted some great stuff on puberty & what's going on with the hormones that you might be able to find in a search.
     
  8. kiwikid

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  9. Ali

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    As a now very adult T1 but once a teen T1 this is a great article and worth remembering that even post teen years there is for some T1s hormonal issues that complicate stuff for many many years. Thank you for posting this great article. One of the pluses of the development of CGMS technology will be the validation of many of these underlying issues which for years physicians have assumed were due to patient non compliance. I believe the data from CGMS use will be a real wake up to many in the T1 arena. Ali
     
  10. wilf

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    Awesome article. :)

    For those going through puberty and not on CGMs my advice is measure often and be VERY flexible in terms of adjusting insulin dosages based on the needs of the moment. None of this wait 3 days before changing basals etc..
     
  11. StacyMM

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    My son is in puberty and my daughter in early puberty. It has been crazy. DS hasn't been too bad - just highs when he is busy growing (he grew 1.25 inches in a month recently!!!) but his honeymoon ended as puberty was beginning so we jumped from something like 12 units basal to 35 in a very short time period. DD has been much trickier. She isn't cycling regularly but we are seeing those early, non regular swings. We keep basal profiles of 10% increases and cycle through them! then drop suddenly for a few weeks. On the low end, her daily basal rate is around 50 but on the high end it climbs so much. Right now she's on a basal profile of 76 units and that includes running about 4u an hour between 9:00 and midnight every night. And her low basal used to be 45, so even her lowest days are higher now. I agree with the PP that said to be aggressive - no waiting for 3 days. My first non-food high and I bump her basals up. And when I think about how many years this is going to last, I sigh.

    Off to read that article now. Hopefully it cheers me up :)
     
  12. roo'smom

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    Thank you all for the replies and the article. Judging from what you all are going through I feel comfortable being more aggressive with her basals. I know in my mind that they need whatever amount of insulin does the job, but it just seemed like SO much. She has an endo appt on Friday, so I'll also be looking at getting a Dex. She had a MM CGM, but we were less than thrilled with the data we got from it, she despised the insertion (as did I), so the fight really wasn't worth it. That was a couple of years ago though. Thanks again!
     
  13. Darryl

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    Expect basal rates will vary from almost nothing up to 3u/hr routinely and even 5u/hr from time to time (these high basal rates are sometimes needed for 4 to 6 hours at a time). CGM's are particularly helpful because they not only allow you to act early to prevent BG from going excessively high, but also because the high basal needs also end suddenly and the CGM helps you see, for example, when BG starts to drop from 150 to 120 in a short time which gives you time to turn off the basal or eat some carbs to prevent a low once the high basal is no longer needed.

    As Wilf said - if not using a CGM test often during these years (I will add that this is especially important during sleep - I check every 1 to 2 hours at times when the CGM is not working), and be prepared to change basal rates throughout the day in response to persistent highs and lows as these don't follow any regular schedule. In the past few years, we've had basal rates that are for the most part about 1u/hr all day, modified every few hours based on the CGM's readings. Adjustments are different each day.
     
  14. Sarah Maddie's Mom

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    Puberty is hard. And long - I feel like we've been dealing with these issues for the past 4 years. My advice is, don't expect their A1c to be as good as before or as what it will be later. It's a complicated, important time for all kids, but even more complicated and potentially dangerous time for ours. Sometimes "great control" takes a back seat because "good enough" and even just , "safe" are a better fit with being an emotionally healthy teen. You have to find a balance - it's not easy.
     
    Last edited: Feb 18, 2014
  15. Hstntxag

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    This was such a timely thread for me to find. I have been so leery of aggressive basal changes because my son was so sensitive to slight basal changes but I have jhad no choice as the highs aren't budging! Thanks for info. I knew the high numbers were going to come but I was totally caught off-guard the last 3 days.
     
  16. mmgirls

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    No puberty here and I hope my dd is a "late bloomer" like I was, but have to say that having a very active girl like mine, I already do weigh the "good enough" to "safe", especially when she will be away, which is more and more.
     

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